DDW-2025-004850

Water Hauling Proposal – Approval Form
INSTRUCTIONS
Send the completed Plan Approval Template to [e-mail]
Definitions:PWS refers to the Public Water System requesting approval to receive the hauled water.
Supply PWS refers to the Public Water System supplying hauled water.
Water Hauler refers to the entity transporting the hauled water.
WATER HAULING PROPOSAL INFORMATION
PWS Name: PWS No.:
Reason for water hauling:
How the water will be used
(consumption, bathing, etc.):
Hauling start date: Hauling end date:
Supply PWS Name: Supply PWS Number:
Supply location or element
(tank, hydrant, etc):
Water Hauler Name: Water Hauler Email:
Water Hauler Type: Contractor PWS Other Disinfectant meets ANSI/NSF
Standard 60:Yes
No
Volume of water per haul
(gal):
Haul frequency (twice daily,
twice weekly, etc.):
Describe the vehicles, tanks,
and equipment that will be
used to transport water:
Cleaning and disinfection
frequency and method:
Chlorine monitoring
frequency and method:
Acknowledgements I understand the PWS must submit the Water Hauling Report to [e-mail] monthly, no later than
the 10th of the following month (e.g. the report for January must be submitted by February 10th).
I understand any changes to the approved Water Hauling Proposal, including changes to the dates of
hauling, must be submitted to [e-mail]
I understand approvals or permits from the local authority or county may be necessary before beginning
water hauling.
SUBMITTED BY
Name:
Organization: Title:
Email: Phone:
Signature: Date:
REVIEWED BY
DDW Permitting Engineer
Name:Date:
Email:Phone:
Approval start date:Approval end date:
Comments:
APPROVED BY
DDW Permitting Manager
Name:
Signature:Date:
OFFICE USE ONLY
DDW File No.:CC:
EQ Docs #:
Enclosures:
Admin. Contact Name:
Admin. Contact Address: